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twin birth

Preparing for a Multiple Birth

Options for giving birth to twins. Some questions answered.

Is it possible to have twins vaginally? Yes it can be possible to give birth to twins vaginally depending how your twins are progressing and how they’re lying in the uterus. If they are progressing well, you and your twins don’t have any medical complications, and one of them has his/her head down and engaged towards the end of the pregnancy, you may be encouraged to try a vaginal birth.
It is likely that you will be encouraged to have an epidural so that should they need to top your pain relief up to full strength during the birth so you can have an emergency caesarean they can do so easily.

However it’s more common for monozygotic monoaminotic twins to be given a caesarean due to possible complications but if you wish to discuss your options with your consultant or midwife then that’s fine. It’s important that you understand the reasoning behind whatever decisions you have to make regarding the birth.
Will I have to have a caesarean with twins? Not necessarily. It depends on a number of factors, including how urgently your twins need to be born, how they are presented (how they are laying in the uterus) and if there are any other medical factors to be considered.

If there are complications, or the babies are in distress, the twins are laying in an awkward position, are monozygotic monoamniotic or are breech, you may be advised to have them by caesarean section.

If you attempt vaginal delivery and the labour does not progress as expected, or if there are any difficulties, or the twins need to be born quickly, you might have an emergency caesarean after attempting labour. I’ve had a caesarean with my older child, does this mean that I have to have another one with my twins? Not necessarily. It can be possible to have a VBAC (vaginal birth after caesarean). If you would like to try this please ask your obstetrician for advice.

How will a twin birth differ from that of a singleton? If you have them vaginally you will go through the pushing stages twice, but the first stage (the dilation) and the third stage (delivery of the after birth) is the same.
With a twin birth the midwife/ obstetrician is likely to want to monitor your twins hearts closely for signs of distress which may limit how mobile you are during the birth.

You may be discouraged from having a home birth, or a water birth. However it is always worth discussing with your health team what options are available to you.

How long does it take to give birth to twins? Around the same length of time as with singletons, the only bit that is longer is the pushing bit. It may only take 10-30 mins longer than giving birth to a singleton.

With a caesarean the babies are lifted out quickly so again it shouldn’t take much longer than with a singleton

.There are lots of junior staff wanting to watch but I don’t want them to, what shall I do?
You might find that you have lots of staff present, particularly senior staff such as a consultant or senior midwife which can be reassuring. However you may also find that you have lots of student doctors and midwives wanting to watch for training purposes. If you would prefer that junior staff are not present for the birth please politely say so at the beginning of your labour. If you are happy for them to stay then that is equally fine but at the end of the day, it’s up to you what you want to happen.

The Birth.
You may spontaneously go into labour, you may have to be induced or for a health concern you may have to have a caesarean, either an elective caesarean on a set date that you’ve prearranged, or as an emergency.

If you are induced this involves them inserting a pessary into your vagina which (hopefully) stimulates labour. You then lay down for about 10 minutes to let it take effect. If the first one does not work they may give you a second one about 12 hours after the first one.Spontaneous labour. This is where you start labour without any medical intervention.

 How will you know if you are in labour?  As soon as you notice any of these symptoms please contact your labour suite for advice. Once you get into hospital you will have an internal examination to see how far dilated you are.

If labour is becoming established you will be monitored, probably offered an epidural and moved to a delivery room. The room you are in is likely to double up as an operating theatre if necessary, just to be on the safe side.

You may be offered other forms of pain relief, including a tens machine, pethidine (an injection) or Gas and Air (entonox). See what you need during the labour, if you need more than one kind of pain relief that is fine, tell your midwife so she can organize it. Will I have to go through labour twice if I am having twins?No.

Once you get to the pushing stage you will do the pushing stage twice, but the rest of your labour is the same as having a singleton (apart from getting two babies at the end, obviously!)  After the birth you will deliver the placenta, the babies umbilical cords will be cut, they will be checked over and then handed to you as long as they have no urgent medical issues. After this you are likely to be given a cup of tea and some toast, and shown how to breastfeed if you’re planning on breastfeeding them.

Having a caesarean.
If your caesarean is elective (i.e pre-arranged) you will be able to plan for the birth. You may be offered a choice of having a general anaesthetic where you will be unconscious (asleep) for the birth or a local anaesthetic where you will be conscious during the birth. A caesarean involves having an incision in the abdomen, both babies being carefully lifted out and the abdomen stitched back up again. This is a major operation and takes a little while to recover from. You will be expected to stay in hospital for a few days to recover.

Recovering from a twin birth
Whichever method you use to give birth, you will need time to recover afterwards. Rest is important as is eating well and drinking plenty of fluids. Taking short walks even if it is just up and down the corridor in the hospital is a good idea too as soon as you’re able to.

If you have stitches from an episiostomy ( a cut to your perineum) you may be sore for a few days. If it hurts whilst you urinate (wee) try soothing the area with some warm water and drink plenty, this will dilute your urine and make it sting less.

If you have a caesarean you will need extra help picking up your twins for feeding /changing etc. You will also be monitored to make sure you are recovering after your operation and have your dressings changed and your wound checked.If you’re feeling particularly sad or unwell please contact your health team for advice.

After the birth you will bleed (a bit like a heavy period) for 4-6 weeks. This is known as lochia. If you notice large clots of blood, are very heavy or notice an offensive smell, please contact your hospital immediately.

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What to pack in your hospital bag if you’re having twins

 

Pack the following for yourself:
• An old baggy t-shirt or nighty for the birth.
• Breast pads
• Tissues
• Your toiletries bag with soap, shampoo, conditioner, moisturiser, toothbrush, tooth paste, deodorant, comb, brush. Buy travel size bottles of shampoo, deodorant, etc rather than full size ones. Saves you lugging your whole bathroom cabinet with you!
• An old flannel
• 2x hand towels
• Maternity Pads (or heavy flow sanitary towels)
• Old knickers (not g-strings or anything very skimpy. Big granny pants are best) or disposable maternity pants
• Dressing gown
• Slippers
• Fresh nighty/ Pyjamas. Pyjamas will be fine even after a c-section because they sit higher up than your scar.
• Maternity/Nursing bra
• Mobile phone and/ or camera
• Socks

For the babies
• 2 packs of newborn nappies (if they come in a double pack already one pack should be enough for now!) It’s important not to over do it, because sometimes twins can be surprisingly big/small and need a different size of nappy to what you might think!
• 4 pairs of scratch mitts
• 12 body suits (vests)
• 12 baby grows (sleep suits)
• 2 baby hats
• 2 towels
• 2 cardigans
• Nappy sacks
• Sensitive wipes (check they are suitable from newborn)
• Pleat of cotton wool
• Baby soap, shampoo etc (check if suitable for newborn)
• 6 bibs
• Muslin squares (optional)
• Carrier bags to put dirty clothes in.

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How will my twin pregnancy differ from a singleton pregnancy?

Pregnant WomanYou will find that you will usually get bigger quicker, wear maternity clothes sooner than with a singleton pregnancy.
You may have more severe pregnancy symptoms (although not all twin mums do) You will be scanned more frequently than with a singleton, especially if you are expecting monozygotic (’identical’) twins who are sharing a chorion.

You’re more likely to be seen by a consultant. Twin pregnancy is also usually slightly shorter than a singleton pregnancy. You may need to go on Maternity Leave sooner than if you were having one baby. However it largely depends on how your pregnancy is progressing and how strenuous your job is.

What happens next? Once you’ve established your pregnant you normally get invited to a ‘booking in’ appointment where you meet the midwife at around 10-12 weeks. In this appointment you will have your blood pressure checked your urine sample will be tested and your weight checked.

Your midwife will take a blood sample to determine what blood group you are and if you are rhesus positive or negative.

You will also be asked about your family medical history and about any previous pregnancies. You might find out very early on that you are pregnant and have quite a wait before you go to your booking in appointment. If this is the case and you have questions for your midwife in the mean time please don’t hesitate to contact him/her or your GP.

If you have any health worries at all, go to your GP, midwife or A&E if appropriate. If you have vaginal bleeding, severe morning sickness, severe or prolonged headaches (especially after 20wks), any sign of swelling seek medical attention urgently.

It can be useful to buy a small notebook to jot down any questions you might have for your health team about your twin pregnancy. Make sure you leave plenty of space to jot down the answers to the questions and take a pen with you!

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